Talking about suicide: An uncontrolled trial of the effects of an Aboriginal and Torres Strait Islander mental health first aid program on knowledge, attitudes and intended and actual assisting actions.

Gregory Armstrong,Eliza Pross,Anthony F Jorm,Andrew Mackinnon,Nicola Reavley,Georgina Sutherland

doi:10.1371/journal.pone.0244091

Gregory Armstrong, Eliza Pross + Show 4 more

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https://doi.org/10.1371/journal.pone.0244091

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Abstract

Suicide is a leading cause of death among Aboriginal and Torres Strait Islander people. Friends, family and frontline workers (for example, teachers, youth workers) are often best positioned to provide initial assistance if someone is at risk of suicide. We developed culturally appropriate expert consensus guidelines on how to provide mental health first aid to Australian Aboriginal and Torres Strait Islander people experiencing suicidal thoughts or behaviour and used this as the basis for a 5-hour suicide gatekeeper training course called Talking About Suicide. This paper describes the outcomes for participants in an uncontrolled trial of this training course. We undertook an uncontrolled trial of the Talking About Suicide course, delivered by Aboriginal and Torres Strait Islander Mental Health First Aid instructors to 192 adult (i.e. 18 years of age or older) Aboriginal and Torres Strait Islander (n = 110) and non-Indigenous (n = 82) participants. Questionnaires capturing self-report outcomes were self-administered immediately before (n = 192) and after attending the training course (n = 188), and at four-months follow-up (n = 98). Outcome measures were beliefs about suicide, stigmatising attitudes, confidence in ability to assist, and intended and actual actions to assist a suicidal person. Despite a high level of suicide literacy among participants at pre-course measurement, improvements at post-course were observed in beliefs about suicide, stigmatising attitudes, confidence in ability to assist and intended assisting actions. While attrition at follow-up decreased statistical power, some improvements in beliefs about suicide, stigmatising attitudes and intended assisting actions remained statistically significant at follow-up. Importantly, actual assisting actions taken showed dramatic improvements between pre-course and follow-up. Participants reported feeling more confident to assist a suicidal person after the course and this was maintained at follow-up. The course was judged to be culturally appropriate by those participants who identified as Aboriginal and/or Torres Strait Islanders. The results of this uncontrolled trial were encouraging, suggesting that the Talking About Suicide course was able to improve participants' knowledge, attitudes, and intended assisting actions as well as actual actions taken.

Highlights

Suicide is a leading cause of mortality for Aboriginal and Torres Strait Islander peoples in Australia, ranking in as the fifth leading cause of death in 2018 [1]
We undertook an uncontrolled trial of the Talking About Suicide course, delivered by Aboriginal and Torres Strait Islander Mental Health First Aid instructors to 192 adult (i.e. 18 years of age or older) Aboriginal and Torres Strait Islander (n = 110) and non-Indigenous (n = 82) participants
No consent was sought from participants to make the data publicly available, nor was it sought from the Aboriginal Community Controlled Health Organisations (ACCHOs) and other Aboriginal Corporations or community organisations, who gave permission for the training courses and associated data collection in their communities

Summary

Introduction

Suicide is a leading cause of mortality for Aboriginal and Torres Strait Islander peoples in Australia, ranking in as the fifth leading cause of death in 2018 [1]. High rates of Indigenous suicide are a distressing phenomenon in several other postcolonial countries, for example, Canada, the United States and New Zealand [4]. Gatekeeper training teaches groups of people in the community how to identify and support individuals who are at high risk of suicide and to refer them to appropriate community supports, including mental health services [19]. A systematic review of suicide prevention interventions targeting Indigenous populations in Australia, Canada, New Zealand and the United States found that gatekeeper training demonstrated encouraging results, with significant short-term increases in participant knowledge, skills, intentions to assist, and confidence in identifying and assisting individuals at risk of suicide [16]

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